The head of The Gates Foundation reveals the biggest challenge in the world right now

As the CEO of the Bill and Melinda Gates Foundation, Sue Desmond-Hellmann is entrusted with the tricky — and incredibly important — task of helping to figure out where the largest private foundation in the world should put its money.

Desmond-Hellmann, the former chancellor of the University of California, San Francisco and an oncologist by training, has been at the foundation for two years. Now she’s taking stock with a progress report detailing what the Gates Foundation is all about (in a nutshell: a belief that all lives have equal value, and that everyone deserves opportunities for a healthy and productive life) as well as the wins and tough lessons from the foundation’s recent work in everything from polio to education.

Tech Insider spoke with Desmond-Hellmann about what the Gates Foundation has been working on during her tenure as well as where it’s going in the future.

Interview edited for clarity and length.

Tech Insider: What have been the biggest accomplishments at the foundation during your time so far?

Sue Desmond-Hellmann: For me, the most important accomplishment is in some ways changing expectations. Some people [have] felt like global poverty was inevitable, intractable, and not open to getting better. And so I think the Foundation’s optimism, sense of purpose, sense of urgency, and use of analytics are profoundly important in changing expectations and pace in work on global health and global development.

That ranges from things like having invested in a meningitis vaccine in sub-Saharan Africa that’s changed our opportunity to fight meningitis deaths, the investments in polio, investments in malaria that have markedly decreased malaria incidents, investments in HIV, tuberculosis, maternal and child health.

I’d point out a couple approaches I think are particularly notable. One approach is the willingness of the Foundation to invest in research and development in earlier stage things. So we’re willing to invest in biology — in understanding immunology or new gene editing, in novel ways of quickly producing vaccines for infectious diseases — because we don’t have to make money. We can take a very long term view and we can take risks in that R&D investment.

The second [approach] is a willingness to work with the private sector that lets us tap into all the intellect and capabilities that the private sector has.

TI: You mentioned polio just now, and that’s also mentioned in the letter as well. I was just reading a piece where Bill and Melinda Gates were saying it’s possible we’ll see the last polio case ever this year. How are the Gates Foundation investments helping to make this possible, and how far along are we in that fight?

Desmond-Hellmann: What I think is just profoundly important is that the polio work is a partnership. It’s work that we’re doing with partners like WHO, UNICEF, Rotary, and with national governments.

The best news is that Nigeria and therefore the continent of Africa has now been more than a year free of wild polio virus. That is a profound accomplishment for the globe. It took enormous investments in everything from improving the supply chain to human resources for vaccinators to community campaigns.

The last places on earth where polio remains are Pakistan and Afghanistan. The good news is so far this year there’s only been 14 cases of polio globally and so it feels like we’re at the end game.

We’re also investing on the technology side in thinking about better polio vaccines. We’ve got a portfolio of investments in polio vaccinations so when the world is polio-free, there are tools that can keep us safe.

TI: The foundation is investing in agtech companies like AgBiome, as well as agricultural development in general. What’s the philosophy behind those investments?

Desmond-Hellmann: In agriculture, our strategy is to focus on smallholder farmers. They need to have the tools to maximise their productivity — so they can feed their families, access the markets to generate some cash, use that cash for education, health, and other things for their families.

We’ve made investments in a few areas. One is in livestock. How do farmers ensure they have healthy livestock? So it may be that we’re investing in a vaccine for livestock that helps avoid things like hoof and mouth disease or other ailments that can interfere with raising cows.

In crops, there are investments we can make in soil health, seeds, and inputs like fertiliser, as well as investments in what people call farmer extension or training for smallholder farmers.

Because we’re a foundation, we can think long-term and high risk. So we make investments in science. And we’ve contributed to investments in better utilising and understanding the microbiome. A lot’s been written about the microbiome in humans now, and we’re very interested in that, particularly as it relates to stunting and wasting in childhood development, particularly in areas where diarrhoea is a big problem.

The other investments that’s interesting in the microbiome [area] is in the soil microbiome and how understanding that can help people think about productivity, crop rotation, seeds, and inputs. Understanding the soil microbiome has become a relatively recently recognised part of maximizing productivity for smallholder farmers.

TI: A lot has been made in the past of the foundation’s work with GMOs. How do you see that work fitting into [your agricultural investments], and is it a significant part?

Desmond-Hellmann: It’s actually a very small part of the portfolio of investments we’re making in agriculture today. We’re interested in helping farmers. So when we look at GMOs, it comes in two ways. One is having a very scientifically-driven approach to working with the smartest scientists globally, asking questions about the evidence that GMOs are helpful, and whether we’re confident that there’s no harm — like we would with any innovation.

In particular, how could this help farmers? What’s the biology, what’s the likelihood of success, how has this advanced, and what’s the evidence that it’s helping? And how can we measure potential positive and negative consequences of GMOs?

There’s another aspect of GMOs [to think about] with policy, though. Various populations and communities have raised concerns about GMOs. We’re very aware of that, and we work with local governments. If a government has a particular point of view towards GMOs, we have to incorporate that into how we interact with farmers.

TI: What do you see as the biggest challenges in the world today, particularly those where the foundation can make a difference?

Desmond-Hellmann: There’s a global conversation going on about women and girls. One of the things that Melinda has been championing is a new $80 million investment on data in gender.

When you look at what I just talked about with smallholder farmers, the ability of women to have agency globally, whether that’s the ability to get a STEM education, access capital for farming, save money to send kids to school, have access to modern contraception — I think there’s something there that’s really profound involving innovation and inclusion. As one of 5 sisters and a female scientist and leader myself, I think that’s special right now.

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